Cerebrospinal Fluid Lactate Levels and Prognosis in Status Epilepticus

Calabrese, Vincent P.; Gruemer, H D; James, Kaitlin C.; Hranowsky, Nicholas; DeLorenzo, Robert J.

doi:10.1111/j.1528-1157.1991.tb05538.x

Cited by 39 publications

(24 citation statements)

References 35 publications

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“…Low CSF glucose, often in combination with low CSF lactate, can also be found in patients with GLUT1 deficiency syndrome, a treatable genetic metabolic disorder that is caused by impaired glucose transport into brain [5]. CSF lactate can be elevated in several disorders, such as subarachnoidal hemorrhage, bacterial meningitis [3], cerebral hypoxia [6], status epilepticus [7], and inborn errors of metabolism [8]. Age-specific reference values are needed for an accurate interpretation of the results of CSF analysis and differential diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5–95th percentile ranges. CSF glucose 5th percentile values ranged from 1.8 to 2.9 mmol/L and 95th percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5th percentile values ranged from 0.41 to 0.53 and 95th percentile values from 0.82 to 1.19. CSF lactate 5th percentile values ranged from 0.88 to 1.41 mmol/L and 95th percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

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Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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“…1 2 However, CSF lactate may also be raised in association with many other illnesses including seizures, 3 meningitis, 4 encephalitis, and cerebral ischaemia. In order to determine the value of measuring CSF lactate, we have reviewed the records of 158 children who attended a tertiary referral hospital with concentrations greater than or equal to 2 mmol/l.…”

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The significance of elevated CSF lactate

Chow

2005

Archives of Disease in Childhood

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“…Thus, the L/P ratio is classically considered as a marker of cytosolic redox status (NADH/NAD ϩ ) (1 ). Several acquired disorders, such as bacterial meningitis (2 ), cerebral hypoxia (3 ), and status epilepticus (4 ), can increase the cerebrospinal fluid (CSF) lactate concentration. Lactate concentrations in CSF have also been reported to be increased in individuals with several inborn errors of metabolism (IEM) that can affect the central nervous system, such as pyruvate dehydrogenase (PDH) deficiency (5 ), and respiratory chain (RC) disorders (6 ).…”

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confidence: 99%

“…To our knowledge, only one published study has given the usual range of both lactate and pyruvate in CSF, but it was based on adult cisternal puncture samples (7 ). Only CSF lactate ranges have been established in children, in small cohorts (2,4,8,9 ).…”

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Cerebrospinal Fluid Lactate and Pyruvate Concentrations and Their Ratio in Children: Age-related Reference Intervals

Benoist

Alberti

Leclercq³

et al. 2003

Clinical Chemistry

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Background: Lactate (L) and pyruvate (P) concentrations in cerebrospinal fluid (CSF) and the L/P ratio have diagnostic value in numerous primary and acquired disorders affecting the central nervous system, but agerelated reference values are not available for children. Methods: We analyzed CSF and blood lactate and pyruvate concentrations and their ratio in a 4-year retrospective survey of a children's hospital laboratory database. Reference intervals (10th-90th percentiles) were established from data on 197 hospitalized children. A recent regression modeling method was used to normalize and smooth values against age. The model equation of best fit was calculated for each variable. Results: Slight age-related variations were shown by the model, with an increase in lactate, a decrease in pyruvate, and a resulting increase in the L/P ratio with increasing age. However, the SD did not vary with age. We defined the upper limit of the reference intervals as the 90th percentiles, which from birth to 186 months of age varied continuously from 1.78 to 1.88 mmol/L (6%), 148 to 139 mol/L (6%), and 16.9 to 19.2 (14%) for lactate, pyruvate, and the L/P ratio, respectively. At a threshold of 2 (in Z-score units), the sensitivity for a subgroup of inborn errors of metabolism (respiratory chain disorders) was 73%, 42%, and 31% for lactate, pyruvate, and the L/P ratio, respectively. Conclusions: In children, CSF lactate and pyruvate concentrations and their ratio appear to vary slightly with age. Average 90th percentile values of 1.8 mmol/L, 147 mol/L, and 17, respectively, could be used in

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Cerebrospinal Fluid Lactate Levels and Prognosis in Status Epilepticus

Cited by 39 publications

References 35 publications

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

The significance of elevated CSF lactate

Cerebrospinal Fluid Lactate and Pyruvate Concentrations and Their Ratio in Children: Age-related Reference Intervals

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